Basic Information
Provider Information
NPI: 1467923482
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MAY
FirstName: CORY
MiddleName: PATRICK
NamePrefix: MR.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1055 E COLORADO BLVD STE 560
Address2:  
City: PASADENA
State: CA
PostalCode: 911062380
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 1479 SARATOGA AVE
Address2:  
City: SAN JOSE
State: CA
PostalCode: 951294934
CountryCode: US
TelephoneNumber: 8779910009
FaxNumber: 8182416853
Other Information
ProviderEnumerationDate: 12/17/2018
LastUpdateDate: 01/17/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/17/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
106S00000X  Y    

No ID Information.


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